Grant Funding in Oklahoma Changes Systems for Accessing and Addressing Tobacco Use

Strategy: Integrate Screening for Tobacco Use into Behavioral Health Treatment

The Oklahoma Tobacco Settlement Endowment Trust (TSET) works to reduce tobacco use in the state using funds from the Master Settlement Agreement.1 In 2011, TSET brought together Oklahoma’s Department of Mental Health and Substance Abuse Services (ODMHSAS) and State Department of Health to develop a plan to address tobacco use among behavioral health clients and providers. After this meeting, facilitated by the Smoking Cessation Leadership Center, TSET awarded grants to health system partners to help put the plan in place.2

Required state-funded behavioral health facilities to have tobacco-free policies for staff and clients and show plans for enforcing the policies,

Required state-funded behavioral health facilities to implement the “5 A’s” (five steps for clinicians to help people quit tobacco: Ask, Advise, Assess, Assist, and Arrange3) or to refer clients who use tobacco to the state quitline, and

Required state-funded behavioral health providers to track the number of clients they referred to the quitline and increase the proportion of clients referred each year.

ODMHSAS staff say that these steps helped change the culture around tobacco use in behavioral health treatment settings in Oklahoma. After ODMHSAS took these steps, Oklahoma changed its behavioral health treatment regulations. Now Oklahoma law requires that the above measures be taken by all substance use disorder treatment facilities and all state-funded or state-certified mental health facilities. ODMHSAS is now focusing on reducing tobacco use among clients at all mental health facilities in the state – even if these facilities are not state-certified or state-funded – to help improve health.

This effort appears to be making an impact: Oklahoma has the highest proportion of mental health treatment facilities offering cessation counseling, offering non-nicotine cessation medications, and providing smoke-free campuses in the U.S. ODMHSAS staff report that only 45% of persons with a mental health condition who were served by ODMHSAS smoked in 2017, down from 71% in 2011. During this same timeframe, the proportion of persons with a substance use disorder served by ODMHSAS that smoked fell from 77% to 51%.

The five major steps to help people quit are commonly referred to as the “5 A’s,” because each step begins with the letter A: Ask patients about tobacco use; Advise patients to quit using tobacco; Assess whether patients are ready to try to quit; Assist patients who want to quit by offering them counseling, NRT, or non-nicotine medication; and Arrange for a follow-up discussion. Agency for Healthcare Research and Quality. Five Major Steps to Intervention (The “5 A’s”)External. Accessed March 29, 2018.